Volume 14 Issue 5
Sep.  2023
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ZHANG Di, NING Xiaohong. Ethical Arguments for Withdrawing Life-sustaining Medical Intervention[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(5): 1116-1122. doi: 10.12290/xhyxzz.2022-0332
Citation: ZHANG Di, NING Xiaohong. Ethical Arguments for Withdrawing Life-sustaining Medical Intervention[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(5): 1116-1122. doi: 10.12290/xhyxzz.2022-0332

Ethical Arguments for Withdrawing Life-sustaining Medical Intervention

doi: 10.12290/xhyxzz.2022-0332

Education Reform Projects of Chinese Academic of Medical Sciences & Peking Union Medical College 2019zlgc0119

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  • Corresponding author: NING Xiaohong, E-mail: ningxh1973@foxmail.com
  • Received Date: 2022-06-15
  • Accepted Date: 2022-08-30
  • Available Online: 2022-09-23
  • Publish Date: 2023-09-30
  • Decision to withdraw life-sustaining medical intervention(LSMI) is a common ethical issue in clinical practice. This paper reviews and analyzes the ethical arguments for withdrawing LSMI from three aspects: respect for autonomy, medical futility and patients' best interests. The authors argue that withdrawal of LSMI can be ethically justified when any of the following conditions is met: when patient gives valid consent, LSMI is judged to be medically futile, or it is in the patients' best interests. This paper proposes practical suggestions for the withdrawal of LSMI in clinical practice, and presents several policy suggestions. Finally, the authors identify several challenges of withdrawing LSMI in practice and possible approaches to addressing them.
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  • [1] Zhu Y, Zhu X, Xu L, et al. Clinical Factors Influencing End-of-Life Care in a Chinese Pediatric Intensive Care Unit: A Retrospective, post-hoc Study[J]. Front Pediatr, 2021, 9: 601782. doi:  10.3389/fped.2021.601782
    [2] Liu H, Su D, Guo X, et al. Withdrawal of treatment in a pediatric intensive care unit at a Children's Hospital in China: a 10-year retrospective study[J]. BMC Med Ethics, 2020, 21: 71. doi:  10.1186/s12910-020-00517-y
    [3] Baker J. A matter of life and death[J]. J Med Ethics, 2017, 43: 427-434. doi:  10.1136/medethics-2017-104256
    [4] Janofsky JS, Mccarthy RJ, Foistein MF. The Hopkins Competency Assessment Test: a brief method for evaluating patients' capacity to give informed consent[J]. Hosp Community Psychiatry, 1992, 43: 132-136.
    [5] Etchells E, Darzins P, Silberfeld M, et al. Assessment of patient capacity to consent to treatment[J]. J Gen Intern Med, 1999, 14: 27-34. doi:  10.1046/j.1525-1497.1999.00277.x
    [6] Tay M, Chia SE, Sng J. Knowledge, attitudes and practices of the Advance Medical Directive in a residential estate in Singapore[J]. Ann Acad Med Singap, 2010, 39: 424-428. doi:  10.47102/annals-acadmedsg.V39N6p424
    [7] Wiesing U, Jox RJ, Hessler H, et al. A new law on advance directives in Germany[J]. J Med Ethics, 2010, 36: 779-783. doi:  10.1136/jme.2010.036376
    [8] Wade D. Back to the bedside? Making clinical decisions in patients with prolonged unconsciousness[J]. J Med Ethics, 2017, 43: 457-458.
    [9] Menikoff JA, Sachs GA, Siegler M. Beyond Advance Directives--Health Care Surrogate Laws[J]. N Engl J Med, 1992, 327: 1165-1169. doi:  10.1056/NEJM199210153271612
    [10] Yang PC, Shih MJ, Liu YA, et al. Web Search Trends of Implementing the Patient Autonomy Act in Taiwan[J]. Healthcare (Basel), 2020, 8: 353.
    [11] Hospital Authority. Guidance for HA Clinicians on Advance Directives in Adults[R]. Hong Kong, China: Hospital Authority, 2016.
    [12] 贾平. 缓和医疗、徒劳争端及其法律规制[J]. 医学与哲学, 2021, 42: 1-5, 12.
    [13] Doty WD, Walker RM. Medical futility[J]. Clin Cardiol, 2000, 23: Ⅱ6-Ⅱ16. doi:  10.1002/clc.4960231404
    [14] Schneiderman LJ. Defining Medical Futility and Improving Medical Care[J]. J Bioeth Inq, 2011, 8: 123-131. doi:  10.1007/s11673-011-9293-3
    [15] Mohindra RK. Medical futility: a conceptual model[J]. J Med Ethics, 2007, 33: 71-75. doi:  10.1136/jme.2006.016121
    [16] Helft PR, Siegler M, Lantos J. The Rise and Fall of the Futility Movement[J]. N Engl J Med, 2000, 343: 293-296. doi:  10.1056/NEJM200007273430411
    [17] Brody BA, Halevy A. Is futility a futile concept?[J]. J Med Philos, 1995, 20: 123-144. doi:  10.1093/jmp/20.2.123
    [18] Aghabarary M, Dehghan Nayeri N. Medical futility and its challenges: a review study[J]. J Med Ethics Hist Med, 2016, 9: 11.
    [19] Clarke CM. Do parents or surrogates have the right to demand treatment deemed futile? An analysis of the case of Baby L[J]. J Adv Nurs, 2000, 32: 757-763.
    [20] Limerick MH. The process used by surrogate decision makers to withhold and withdraw life-sustaining measures in an intensive care environment[J]. Oncol Nurs Forum, 2007, 34: 331-339. doi:  10.1188/07.ONF.331-339
    [21] The British Psychological Society. Best Interests Guidance on determining the best interests of adults who lack the capacity to make a decision (or decisions) for themselves[R]. Leicester: The British Psychological Society, 2007: 7-10.
    [22] 薛晓艳, 朱继红. 临终患者不同救治态度的转归及影响因素分析[J]. 医学与哲学, 2011, 32: 27-28, 33. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZL201108013.htm
    [23] 王雪松, 杨新良, 刘玮. ICU不能回避的课题: 生命支持系统的撤除[J]. 医学与哲学, 2009, 30: 66-68. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZL200912028.htm
    [24] 王晓燕, 梁立智, 鲁杨, 等. 医患关系现状的医方因素及对策研究[J]. 中国医学伦理学, 2008, 21: 33-36. https://www.cnki.com.cn/Article/CJFDTOTAL-XNLX200805016.htm
    [25] 李倩. "中断医疗型"安乐死在德国的刑法教义学考察[J]. 北方法学, 2017, 11: 61-71. https://www.cnki.com.cn/Article/CJFDTOTAL-BFFX201705007.htm
    [26] 鲍博. 论医生死亡协助在我国刑法中的正当化: 从比较法的视角[J]. 中国卫生法制, 2021, 29: 77-82. https://www.cnki.com.cn/Article/CJFDTOTAL-WSFZ202101019.htm
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